Newborn transition Assessment Flashcards
What causes the change from fetal to neonatal circulation
Cessation of blood through the umbilical vessels and placenta
How long can it take to transition from intrauterine to extrauterine life?
Up to 12 hours
Fetal to neonatal circulation occurs simultaneously with what
Respiratory adaption
When do the ductus venosus, foramen oval and the ductus ateriousus usually close
Within the first 24 hours of life
What happens with cardiovascular adaption
Closure of the ductus venosus, foramen ovals and the ductus arteriousus
Shift to pulmonary circulation
How long do you count apical impulse in a newborn
Full minute
Where is PMI in a newborn
4th ICS to the left of the MCL
Normal heart rate at birth
120-160
In utero what’s a normal heart rate
Same as at birth. 120-160
Normal capillary refill in a neonatal
Less than 3 seconds
Average systolic and diastolic BP
60-80/40-50
Why are femoral and bracial pulses palpated in neonatal
For symmetry, strength, and rate to provide info about change to adult circulation patterns
Where do you palpate femoral pulse? Brachial?
Femoral- groin
Brachial? Inside of arm
Why do you check both femoral and brachial pulse in neonatal
Coarctation of aorta
Average blood volume in neonatal
300 ml
What can late clamping of the cord lead to
Polycythemia
Normal hemoglobin level in neonatal
14-24 g/dl
Normal hematocrit in a neonatal
44%-64%
Normal RBC in neonatal
4.8-7.1 /mm
Normal WBC in neonatal
9,000-30,000 per mm
Average platelets in neonatal
200,000-300,000
What are the clotting factors
Factor II, VII, IX, and X
Why are clotting factors low in neonatal
Lack of vitamin K
If all the clotting factors are low at birth what could happen
Risk for bleeding
Breathing can be noted as early as ____ weeks gestation
11 weeks
Functioning lungs occurs after ____ weeks gestation
26
When is surfactant found in sufficient quantity
Around 35 weeks gestation
Fetal lung fluid is necessary for development does it increase or decrease with gestational age
It decreases
What helps with the surface tension in lungs
Surfactant
What could low amniotic fluid level mean
Could mean kidneys are not working correctly. Amniotic fluid stays in normal range by peeing so this would show kidneys are working
What does catecholamines do?
Increases the release of surfactant
Catecholamine surge prior to labor corresponds to what
Rapid drop in level of fluid in lung field
What stimulates the aortic and carotid chemoreceptors triggering the medulla initiation of receptors
Decrease oxygen and increase carbon dioxide concentration along with decrease pH
Surfactant increases the lungs ability to do what?
Fill with air
How does surfactant promote lung expansion
By preventing the complete collapsing of the alveoli with each expiration
Compression of the chest during vaginal birth forces ___of the fluid out of the lung fields
1/3
How does crying keep the alveoli open?
Creates positive intrathoracic pressure
What are three examples of sensory stimulation
Tactile
Visual
Auditory
Is there fluid in the lungs until the baby is born?
Yes
When does pulmonary vasodilation occur
As oxygen enters the lungs
What kind of sign is grunting after birth
Never a good sign
Respiratory adaptions are established within _____ after birth
1 minute
Babies are ____ breathers
Nose
Normal respirations for neonate
30-60 per minute
How should you count respirations
For a full minute because they may be irregular
Respirations should be noisy?
No they should be quiet
What does a baby use to breathe
Diaphragmatic and abdominal muscles
What are signs of respiratory distress
Nasal flaring, grunting, costal retractions and a rate less than 30 or more than 60
What is newborns ability to Maintain its temperature controlled by
External environmental factors and internal physiologic process
Heat loss as water evaporates from the skin
Evaporation
Transfer of body heat to surrounding air ( cold delivery room)
Convection
Transfer of heat to surface newborn is lying on
Conduction
Loss of heat through the air to a cooler surface (not in direct contact with the neonate)
Radiation
What do neonates have limited ability to do in order to generate heat?
Shiver
How is heat produced?
By the metabolism of brown fat and babies have less brown fat
Flexion of extremities, restlessness, and crying are examples of what
Voluntary muscle activity which is a thermogenic adaption
With cold stress, Increase glucose utilizes leads to?
Hypoglycemia
With cold stress, Increase oxygen consumption can lead to?
Metabolic acidosis
Signs of cold stress/hypothermia
Skin cool to touch, mottling of the skin, central cyanosis, decreased responsiveness, jittery, tachypnea
How is glucose stored for neonatal metabolic demands
Glucose is stored as glycogen
Due to rapid depletion of glycogen during the first 24 hours the glucose level will be between what ?
50-60 mg/ml
In utero _____ is stored for use in hemoglobin production after birth. If adequate will last till ____ month without needing supplement
Iron
5th
Will you hear bowel sounds as soon as baby is born?
No. Audible bowel sounds will be within first hour
Stomach capacity in neonate
30-90 ml
About 3 oz
When is first meconium passed
12-24 hours
What could cause pink staining in diapers
Uris crystals
How long will,it take renal system to fully mature
1 year
____ ml of urine at birth
40
___-___ voids per day for first 2 days
2-6
___-____ voids per day after 48 hours
5-25
___-___ ml of urine per/kg/day
15-60
Color of urine
Odorless straw color
When do you start immunizations?
8 weeks
What three immunoglobulins does neonate depend on
IgA, IgG, IgM
Steps in initial assessment
Apgar score determined Assess for gross abnormalities Apply cord clamp Obtain foot prints Apply identification bands Administer Vit K and eye prophylaxis Promote bonding
How long is the first period of reactivity
Birth to 30 minutes
Heart rate in first period of reactivity
160-180 bpm
Respiratory rate in first period of reactivity
60-80
Crackles may be present
After the first period of reactivity how long may the newborn sleep
60-100 minutes
How long is the transition second period
4-8 hours
Brief periods of what may happen in transition second period
Tachycardia and tachypnea, usually last only 10 minutes
Average newborn length
19 to 21 inches
Average newborn weight
7 pounds 8 ounces
SGA baby weight
Less than 5 pounds 8 ounces ( less than 10%)
LGA baby weight
Greater than 9 pounds ( greater than 90%)
Newborns can loose up to ___% of birth weight
10%
Normal newborn head circumference
33-38 cm
Normal newborn chest circumference
31-36 cm
A LGA baby may have a hard time doing what
Maintaining glucose
A SGA baby may have a hard time doing what
Maintaining temperature
Normal axillary temperature in newborn
97-99.5 degrees F
What kinds of breathers are newborns
Nose breathers
What respiratory patterns should you observe newborns for
Flaring, grunting, retracting
What should you ascultate newborns for? This is not an ok finding
Rales
What shape is anterior fontanel? When does it close?
Diamond shaped closes in 18 months
What shape is posterior fontanel? When does in close?
Triangle shaped and closes in 8-12 weeks
How should fontanels be
Open and soft
What do depressed fontanels indicate
Dehydration
What do bulging fontanels indicate
May be increased intracranial pressure
What colors are eyes? When does a permanent color establish?
Usually blue or gray. Permanent color establishes in 3-12 months
If red reflex is present what is intact
Cornea
How far can newborns see? Where is clearest vision?
Up to 2 1/2 feet. Clearest vision 8-12 inches
What may low set ears be a red flag for
Chromosomal abnormalities
What could bell shaped chest be a sign of
Undeveloped lungs
What shape should chest be
Cylindrical
What could unequal breath sounds be
Pneumothorax
What is present in umbilical cord
2 arteries, 1 vein
What does flat abdomen indicate
Diaphragmatic hernia
What is supra public area palpated for
Bladder distention
What could not feeling femoral pulse be a sign of
Coarctation of the aorta
In a term newborn what is normal for the female genital
Labia majora covers labia minora and clitoris
Newborns may have mucoid vaginal discharge due to what
Maternal hormones
How would you know if the anus is patent
If they have a stool
Can a hymental tag be present in a newborn?
Yes
When do testes descend?
By a year of Age
What should you check with male genital assessment
Placement of meatus
Is opening of penis is on dorsal surface
Epispadias
If opening of penis is on ventral surface
Hypospadias
What is present on scrotum
Rugae
Hyperflexibility of joints is associated with what
Down Syndrome
Test to assess for hip dislocation in newborns
Ortolani’s
What do Simian creases suggest
Down syndrome
What is dimpling associated with
Spina bifida
What is normal sleep-wake cycle in newborns
45 minutes
Most common sign of pain
Crying
How can you tell intracranial pressure
By fontanel
What does the AAP recommend about infants and breast feeding
That they are exclusively breast feed for first 6 months of life
How long should breast feeding continue
At least 12 months
If infants are weaned before 12 months from breast milk what should they receive
Iron-fortified infant formula
Why is breast milk considered live tissue
Because it contains almost as many live cells as blood
How many lobes are the female breasts composed of? Why are in these lobes?
15-20 lobes embedded in fat and connective tissue, well supplied with blood vessels, lymphatic vessels, and nerves
How does the milk collect ebbing the nipple
Ductles enlarge into lactiferous ducts and sinuses
How is milk transported to the sucking infant
Nipple has 15-20 pores through which milk is transferred
How is prolactin produced
By infant sucking and emptying the breasts
When is prolactin highest
First 10 days
Do the breasts ever completely empty
No
What is oxytocin
Another hormone essential to lactation
What is colostrum
A clear yellowish fluid birth to 48 hours. It is more concentrated than mature milk
What is colostrum extremely rich in
Immunoglobins
When do you see transition milk? What are the characteristics?
48-72 hours
High levels of fats, lactose, and water soluble vitamins. Higher calorie content. Larger volume
When is mature milk produced
By 10th to 15th day
What is percentage of water in mature milk?
90% water. Remaining 10% carbohydrates, fats, and proteins. More water maintains newborns fluid balance
What is the size of a newborns stomach? What about after 7-10 days?
Small marble can hold 5-7 cc’s . After 7-10 days in increases to the size of a golf ball and can hold 1.5 to 2 ounces
How many times do newborns nurse in 24 hour time period
8-12 times
How often do newborns give cues to feed
Every 1-3 hours
What may result from poor latch on
Sore nipples
What does plugged milk ducts result from
Inadequate emptying or underwire bra. You should apply warm compresses prior to nursing
What is characterized by sudden flu like symptoms usually effects only one breast
Mastitis
Small raised white spots on the nose, chin, and forehead
Milia
Bluish purple spots of pigmentation. Commonly on shoulders, back, and buttocks
Mongolian spots
Should the head or chest circumference be larger?
Head should be 2-3 cm larger than chest circumference
Small whit nodules that appear on the roof of a newborns mouth
Epsteins pearls
How is the Moro Reflex elicited
By holding the newborn in a semi sitting position and then allowing the head and trunk to fall backward
Crackles and wheezing are symptoms of what
Fluid or infection In the lungs
